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The State of Health in New Mexico 2018

8. Chronic Disease

Chronic Conditions Pose Challenges for New Mexico

Chronic diseases including heart disease, cancer, emphysema, stroke, and diabetes account for five out of the six leading causes of death in New Mexico. Another common chronic disease, arthritis, is a leading cause of disability among adults. About 1 in 2 adults in the U.S. lives with a chronic disease.

Managing Multiple Chronic Conditions

In this section, "multiple chronic conditions" means having been diagnosed with two or more of the following: cardiovascular disease (heart attack, angina or coronary heart disease, or stroke), current asthma, cancer (excluding skin cancer), COPD (emphysema and/or chronic bronchitis), arthritis, kidney disease, or diabetes.

Learning to successfully self-manage any chronic disease takes education, skill building, adequate time, dedication and resources. Many New Mexicans face the even greater challenge of trying to achieve long term control over more than one chronic condition. In New Mexico in 2016, over 23% of adults ages 45-64 had been diagnosed with multiple chronic conditions, and the rate was over 41% for those aged 65 and older. Lower educational attainment is associated with higher risk in both age groups (Figure 1). This means that many New Mexicans living with the challenge of multiple chronic conditions may not have the health literacy skills, income, community resources, time, or access to healthcare services that they need to take good care of themselves and reduce serious complications.

Recognizing Prediabetes: An Opportunity for Diabetes Prevention

Prediabetes means a person's blood sugar is higher than normal but not yet high enough to be diagnosed with diabetes. People with prediabetes are at increased risk for heart disease, stroke, and developing Type 2 diabetes. In fact, 15-30% of people with prediabetes will develop Type 2 diabetes within 5 years in the absence of interventions. The good news is that this risk can be cut in half when people with prediabetes engage in structured lifestyle programs that result in improved eating habits, moderate physical activity, and a 5-7% weight loss.

There are 1.6 million adults aged 18 years and over in New Mexico. About 235,000 adults in our state have diabetes and most of them, about 8 out of 10, are aware of it (Figure 2). A much larger group of about 538,000 New Mexico adults are estimated to have prediabetes, but only about 3 in 10 are aware of it. This lack of awareness prevents adults with prediabetes from taking important steps to help prevent or delay developing Type 2 diabetes.

Contributing Factors

Risk and Resiliency Factors

Increasing age is the major risk factor for most chronic conditions. Many chronic diseases also share potentially modifiable risk factors such as physical inactivity, tobacco use, excessive alcohol consumption, unhealthy eating, and excess weight. These shared chronic disease risk factors, in turn, are strongly related to potentially modifiable social determinants that tend to cluster in communities, such as poverty, unsafe neighborhoods and housing, unemployment, discrimination, low educational attainment, lack of health insurance, unaffordable healthcare, and limited access to healthy, affordable foods. The chronic stress of these adverse living conditions contributes not only to unhealthy behaviors, but also results in persistently elevated cortisol levels that are believed to play a role in the development of numerous chronic conditions.

Just as adverse social determinants can increase the likelihood of risk factors for chronic conditions, communities that support healthy lifestyles can provide some protection and resilience. For example, creating or modifying environments to make it easier for people to walk or bike helps increase physical activity. Similarly, people who live in places with easy access to healthy, affordable foods are at an advantage compared to those who live where convenience stores and fast food venues are the primary resources for purchasing food.

Health Disparities

As previously noted, lower educational attainment, a marker for lower socio-economic status, is associated with an increased risk for multiple chronic conditions. Similarly, there is a stair step progression in adult diabetes rates in New Mexico from the lowest rates in the two wealthiest household income groups (>$50,000) to the highest rate in the poorest household income group (<$15,000).

Heart disease death rates in New Mexico vary greatly by race and ethnicity. During the 3-year period 2014-2016, the rate for African Americans, 187.5 per 100,000, was statistically significantly higher than that of all other racial/ethnic groups. The next highest rate, that of Whites, 149.7 per 100,000, was statistically significantly different than all remaining racial/ethnic groups. The rates for American Indians and Hispanics were essentially the same. The population with the statistically significantly lowest heart disease death rate was the Asian/Pacific Islander group, rate of 84.4 per 100,000.

Lung cancer is the leading cause of cancer death among both men and women in New Mexico. Figure 3 demonstrates rates of lung cancer deaths for rural and urban counties during 2012-2016. The rates in mixed urban-rural counties, 32.7 per 100,000, were statistically significantly higher than in metropolitan (28.6 per 100,000) or small metro (26.0 per 100,000) counties; rates in rural counties (31.8 per 100,000) were statistically higher than in small metro counties. The association of greater rurality with higher rates of lung cancer deaths tracks with higher smoking rates among adults and youth in those areas.

Assets and Resources

Community programs linked to clinical services, called "community-clinical linkages," can help ensure people with or at high risk of chronic diseases have access to the resources they need to prevent, delay, or manage chronic conditions. The public health sector often leads efforts to build and improve these linkages between community and clinical sectors. A few examples of community-clinical linkages in New Mexico are provided below.

Paths to Health NM/Caminos de Salud NM uses an emerging statewide referral and data system to connect health care providers and individuals with evidence-based community programs. These programs have been developed for people with prediabetes to prevent or delay diabetes, for adults with diabetes or other chronic conditions to develop essential disease management skills, for people who have experienced cancer to address survival issues, and additional chronic disease related programs. Group classes are often held in non-clinical settings such as community and senior centers, as well as worksites. To expand availability, some programs are also offered online. Technical assistance and funding to launch Paths to Health New Mexico are being provided by the Department of Health. (www.pathstohealthnm.org)

Roadrunner Food Bank's Healthy Food Center is a medical referral food pantry at its headquarters in Albuquerque. Several participating health care centers ask patients about their food situations, and the medical professional gives those who are food insecure or consistently hungry a "prescription" for food. The food prescription provides the patient with a voucher to be used at the Healthy Foods Center to improve access to fruits, vegetables, dairy, milk and other healthy food items. (http://www.rrfb.org/about-us/our-programs/)

The Department of Health is sponsoring "office detailing" (onsite outreach and marketing of public health programs and resources) and online training for medical and oral health care providers across the state. This builds systematic tobacco screening and brief intervention efforts in clinical settings, and prompts referrals to effective phone- and web-based cessation services, e.g., the Department's QUIT NOW and DEJELO YA programs, which include free quit coaching in English and Spanish, as well as free nicotine patches and gum. (http://nmtupac.com/)

Step Into Cuba: The Village of Cuba, New Mexico, and the University of New Mexico's Prevention Research Center have teamed up to fight diabetes and other obesity-related diseases through this innovative walking program coordinated by the Nacimiento Community Foundation. Their efforts have created a healthier, more pedestrian friendly community with appealing opportunities for walking and hiking on surrounding scenic public lands. Local clinicians develop individually tailored walking plans with patients and write referrals to the Step Into Cuba walking program. This unique partnership also includes state, local and federal governments; the local school system, and many community volunteers. (https://www.stepintocuba.org/)

Community Health Workers (CHWs), also known as Promotores de Salud and Community Health Representatives, are frontline public health workers who connect members of their own communities with crucial health care and social services. CHWs play a critical role in expanding access to care, reducing health disparities, and coordinating comprehensive care. The Department of Health has worked to build an infrastructure that ensures the training and sustainable integration of CHWs into care teams throughout New Mexico. (https://nmhealth.org/about/phd/hsb/ochw/)

Summary

Among chronic diseases in New Mexico, cancer and heart disease account for the largest numbers of years of life lost before age 75. Those two diseases, along with diabetes, are chronic diseases with the greatest effect on health-related quality of life in New Mexico. Two high priorities around chronic disease are supporting New Mexicans in managing multiple chronic conditions and preventing prediabetes from progressing to diabetes. Community-based initiatives can help increase health-promoting assets and enhance resilience in otherwise resource deficient neighborhoods. Linking these community assets to clinical services creates bidirectional connections for individuals who can benefit most.

Figure 1. Prevalence of Multiple Chronic Conditions among Adults Aged 45-64 and Aged 65+ by Educational Attainment, New Mexico, 2016  Prevalence of Multiple Chronic Conditions among Adults Aged 45-64 and Aged 65+ by Educational Attainment, New Mexico, 2016 Source: NMDOH BRFSS Figure 2. Estimated Numbers of Diagnosed and Undiagnosed Adults Aged 18+ with Prediabetes or Diabetes , New Mexico, 2016 Estimated Numbers of Diagnosed and Undiagnosed Adults Aged 18+ with Prediabetes or Diabetes , New Mexico, 2016 Sources: NMDOH BRFSS, UNM GPS Program, NHANES Figure 3. Average Annual Lung Cancer Deaths per 100,000 Population by Urban and Rural Counties, New Mexico, 2012-2016 Average Annual Lung Cancer Deaths per 100,000 Population, Age-adjusted, by Urban and Rural Counties, New Mexico, 2012-2016 Age-adjusted to U.S. 2000 standard population
Sources: NMDOH BVRHS, UNM GPS Program

What is Being Done?

  • Coalitions such as the New Mexico Chronic Disease Prevention Council (http://chronicdiseasenm.org/), New Mexico Cancer Council (http://nmcancercouncil.org/), and New Mexico Diabetes Advisory Council (https://nmdac.org/) engage public and private organizations and individuals statewide in shared strategic planning and working collaboratively toward population health goals.
  • Chronic disease public health data are readily available to stakeholders and policy makers through queryable websites such as the Department of Health's Indicator-Based Information System (https://ibis.health.state.nm.us) and the Community Data Collaborative data maps site (http://nmcdc.maps.arcgis.com).

What Needs to be Done?

  • Creating sustainable funding mechanisms for effective community-clinical linkages, e.g., chronic disease prevention/self-management programs and CHW services, such as their incorporation into health care networks and health plans as covered benefits.
  • Assessing the potential public health benefits and dangers of all proposed policies and legislation to make decisions that best support the long-term health of New Mexicans.
  • Increasing access to affordable, healthy foods and safe places to be physically active in New Mexico's rural and frontier areas.
The information provided above is from the New Mexico Department of Health's NM-IBIS web site (http://ibis.health.state.nm.us). The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Sun, 16 June 2019 from New Mexico Department of Health, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.nm.us".

Content updated: Tue, 20 Mar 2018 15:16:58 MDT